Neonatal Seizures: Implementation of an EEG Background Grading Scale and Correlation with Seizures in Neonates with and Without HIE
Abstract number :
3.173
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2022
Submission ID :
2205118
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Julie Nelson, MD – Children's Hospital Colorado; Krista Eschbach, MD – Children's Hospital Colorado; Laurel Reed, MD – University of Michigan; Lori Silviera, PhD – University of Colorado School of Medicine
Rationale: To assess how frequently neonatal EEGs were given a background grading classification prior to implementing a specific grading scale to characterize the EEG background at our institution. We then examined the relationship between seizure onset, background classification, and length of EEG monitoring.
Methods: All EEGs performed between 1/1/2020 and 12/31/2020 at Children’s Hospital Colorado on infants with corrected gestational age between 36 weeks 0 days and 43 weeks 6 days were analyzed. Epilepsy providers then underwent training to grade neonatal EEG backgrounds according to a classification scheme. EEGs were analyzed from the period 5/1/2021 through 10/31/2021 to assess for improvement in adherence to grading scale and background classification.
Results: A total of 203 records were obtained. In the first cohort, there were 29/111 (26%) neonates without a background classification. Post-intervention, there were 4/92 patients (4%) without a background classification. 28% of neonates had HIE and were undergoing hypothermia at the time of EEG hook-up. In the HIE group, if the first day of grading was moderately abnormal, neonates were 7.3 times as likely to have had a seizure compared to those with a grading of normal to mildly abnormal (p=0.02). If the first day of grading was moderately abnormal (in all neonates), neonates were 4.5 times as likely to have had a seizure compared to those who had a grading of mildly abnormal (p=0.0011). There were 3 neonates with HIE with grading of normal to mildly abnormal who had seizures, and 2 had seizures in the first 24 hours, and one with seizure at 48-72 hours. Thirteen neonates without HIE with grading of normal to mildly abnormal had seizures; 2 had seizures beginning at hours 24-48 of recording, while the remainder (84%) had seizures in the first 24 hours.
Conclusions: Grading improved with the use of a standardized template and education on grading classification. If the first day of grading was moderately abnormal in both HIE and non-HIE neonates, they were more likely to have a seizure compared to those with a grading of mildly abnormal. Of the neonates with HIE who had normal/mild encephalopathy, the majority (66%) had seizures within the first 24 hours of recording. In neonates without HIE, 84% had seizures in the first 24 hours of recording. We recommend the initiation and use of a standardized neonatal background grading system as background gradings are associated with differing risks of seizure development, and this can help guide management with respect to length of EEG monitoring time.
Funding: None
Neurophysiology